Differentiating macroreentrant from focal atrial tachycardias occurred after circumferential pulmonary vein isolation

Shih Lin Chang; Hsuan Ming Tsao; Yenn Jiang Lin; Li Wei Lo; Yu Feng Hu; Ta Chuan Tuan; Wen Chin Tsai; Chien Jun Chang; Kazuyoshi Suenari; Shih Yu Huang; Ching Tai Tai; Cheng Hung Li; Tze Fan Chao; Tsu Juey Wu; Shih Ann Chen

doi:10.1111/j.1540-8167.2010.02002.x

Differentiating macroreentrant from focal atrial tachycardias occurred after circumferential pulmonary vein isolation

Shih Lin Chang, Hsuan Ming Tsao, Yenn Jiang Lin, Li Wei Lo, Yu Feng Hu, Ta Chuan Tuan, Wen Chin Tsai, Chien Jun Chang, Kazuyoshi Suenari, Shih Yu Huang, Ching Tai Tai, Cheng Hung Li, Tze Fan Chao, Tsu Juey Wu, Shih Ann Chen^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

33 Scopus citations

Abstract

Macroreentrant and Focal Atrial Tachycardias. Background: Atrial tachycardias (ATs) are commonly observed following catheter ablation of atrial fibrillation (AF). The aim of this study was to identify ECG characteristics that differentiate focal from macroreentrant ATs after circumferential pulmonary vein isolation (CPVI). Methods and Results: One hundred and twenty ATs that occurred after CPVI were mapped using a 3-dimensional mapping system in 87 patients with AF. Further ablation was performed to eliminate the ATs. The surface ECGs of 68 ATs in 41 consecutive patients (Group 1) were analyzed retrospectively to create diagnostic algorithms. The algorithms were tested in the second 46 consecutive patients (Group 2). Patients with macroreentrant AT had lower left atrial (LA) voltage than those with focal AT (1.3 ± 0.3 vs 1.5 ± 0.2 mV, P = 0.01). Focal AT had a higher incidence of a positive polarity in V6 compared with macroreentrant AT (88% vs 55%, P = 0.03). The positive amplitude of the flutter/P waves in V6 was higher for focal AT than macroreentrant AT. The cycle lengths of the focal ATs were longer than those for macroreentrant AT (296 ± 107 vs 244 ± 25 ms, P < 0.001). Right atrial macroreentrant AT had a higher incidence of a negative polarity in at least 1 precordial lead compared with LA macroreentry. The positive flutter waves in V1 could differentiate roof/mitral isthmus dependent from non-roof/mitral isthmus dependent macroreentry. This algorithm correctly differentiated the focal from macroreentrant ATs with a sensitivity of 94%, specificity of 91%, and predictive accuracy of 92% in Group 2. Conclusion: Different electrophysiological properties may facilitate the differentiation between macroreentrant and focal ATs after CPVI.

Original language	English
Pages (from-to)	748-755
Number of pages	8
Journal	Journal of cardiovascular electrophysiology
Volume	22
Issue number	7
DOIs	https://doi.org/10.1111/j.1540-8167.2010.02002.x
State	Published - Jul 2011

Keywords

algorithm
atrial fibrillation
atrial tachycardia
ECG

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Chang, S. L., Tsao, H. M., Lin, Y. J., Lo, L. W., Hu, Y. F., Tuan, T. C., Tsai, W. C., Chang, C. J., Suenari, K., Huang, S. Y., Tai, C. T., Li, C. H., Chao, T. F., Wu, T. J., & Chen, S. A. (2011). Differentiating macroreentrant from focal atrial tachycardias occurred after circumferential pulmonary vein isolation. Journal of cardiovascular electrophysiology, 22(7), 748-755. https://doi.org/10.1111/j.1540-8167.2010.02002.x

@article{63557f6ca6cb4e73b248c6edf8f9d6e1,

title = "Differentiating macroreentrant from focal atrial tachycardias occurred after circumferential pulmonary vein isolation",

abstract = "Macroreentrant and Focal Atrial Tachycardias. Background: Atrial tachycardias (ATs) are commonly observed following catheter ablation of atrial fibrillation (AF). The aim of this study was to identify ECG characteristics that differentiate focal from macroreentrant ATs after circumferential pulmonary vein isolation (CPVI). Methods and Results: One hundred and twenty ATs that occurred after CPVI were mapped using a 3-dimensional mapping system in 87 patients with AF. Further ablation was performed to eliminate the ATs. The surface ECGs of 68 ATs in 41 consecutive patients (Group 1) were analyzed retrospectively to create diagnostic algorithms. The algorithms were tested in the second 46 consecutive patients (Group 2). Patients with macroreentrant AT had lower left atrial (LA) voltage than those with focal AT (1.3 ± 0.3 vs 1.5 ± 0.2 mV, P = 0.01). Focal AT had a higher incidence of a positive polarity in V6 compared with macroreentrant AT (88% vs 55%, P = 0.03). The positive amplitude of the flutter/P waves in V6 was higher for focal AT than macroreentrant AT. The cycle lengths of the focal ATs were longer than those for macroreentrant AT (296 ± 107 vs 244 ± 25 ms, P < 0.001). Right atrial macroreentrant AT had a higher incidence of a negative polarity in at least 1 precordial lead compared with LA macroreentry. The positive flutter waves in V1 could differentiate roof/mitral isthmus dependent from non-roof/mitral isthmus dependent macroreentry. This algorithm correctly differentiated the focal from macroreentrant ATs with a sensitivity of 94%, specificity of 91%, and predictive accuracy of 92% in Group 2. Conclusion: Different electrophysiological properties may facilitate the differentiation between macroreentrant and focal ATs after CPVI.",

keywords = "algorithm, atrial fibrillation, atrial tachycardia, ECG",

author = "Chang, {Shih Lin} and Tsao, {Hsuan Ming} and Lin, {Yenn Jiang} and Lo, {Li Wei} and Hu, {Yu Feng} and Tuan, {Ta Chuan} and Tsai, {Wen Chin} and Chang, {Chien Jun} and Kazuyoshi Suenari and Huang, {Shih Yu} and Tai, {Ching Tai} and Li, {Cheng Hung} and Chao, {Tze Fan} and Wu, {Tsu Juey} and Chen, {Shih Ann}",

year = "2011",

month = jul,

doi = "10.1111/j.1540-8167.2010.02002.x",

language = "English",

volume = "22",

pages = "748--755",

journal = "Journal of cardiovascular electrophysiology",

issn = "1045-3873",

publisher = "Wiley-Blackwell",

number = "7",

}

Chang, SL , Tsao, HM , Lin, YJ , Lo, LW , Hu, YF, Tuan, TC, Tsai, WC, Chang, CJ, Suenari, K, Huang, SY, Tai, CT, Li, CH, Chao, TF, Wu, TJ & Chen, SA 2011, 'Differentiating macroreentrant from focal atrial tachycardias occurred after circumferential pulmonary vein isolation', Journal of cardiovascular electrophysiology, vol. 22, no. 7, pp. 748-755. https://doi.org/10.1111/j.1540-8167.2010.02002.x

TY - JOUR

T1 - Differentiating macroreentrant from focal atrial tachycardias occurred after circumferential pulmonary vein isolation

AU - Chang, Shih Lin

AU - Tsao, Hsuan Ming

AU - Lin, Yenn Jiang

AU - Lo, Li Wei

AU - Hu, Yu Feng

AU - Tuan, Ta Chuan

AU - Tsai, Wen Chin

AU - Chang, Chien Jun

AU - Suenari, Kazuyoshi

AU - Huang, Shih Yu

AU - Tai, Ching Tai

AU - Li, Cheng Hung

AU - Chao, Tze Fan

AU - Wu, Tsu Juey

AU - Chen, Shih Ann

PY - 2011/7

Y1 - 2011/7

N2 - Macroreentrant and Focal Atrial Tachycardias. Background: Atrial tachycardias (ATs) are commonly observed following catheter ablation of atrial fibrillation (AF). The aim of this study was to identify ECG characteristics that differentiate focal from macroreentrant ATs after circumferential pulmonary vein isolation (CPVI). Methods and Results: One hundred and twenty ATs that occurred after CPVI were mapped using a 3-dimensional mapping system in 87 patients with AF. Further ablation was performed to eliminate the ATs. The surface ECGs of 68 ATs in 41 consecutive patients (Group 1) were analyzed retrospectively to create diagnostic algorithms. The algorithms were tested in the second 46 consecutive patients (Group 2). Patients with macroreentrant AT had lower left atrial (LA) voltage than those with focal AT (1.3 ± 0.3 vs 1.5 ± 0.2 mV, P = 0.01). Focal AT had a higher incidence of a positive polarity in V6 compared with macroreentrant AT (88% vs 55%, P = 0.03). The positive amplitude of the flutter/P waves in V6 was higher for focal AT than macroreentrant AT. The cycle lengths of the focal ATs were longer than those for macroreentrant AT (296 ± 107 vs 244 ± 25 ms, P < 0.001). Right atrial macroreentrant AT had a higher incidence of a negative polarity in at least 1 precordial lead compared with LA macroreentry. The positive flutter waves in V1 could differentiate roof/mitral isthmus dependent from non-roof/mitral isthmus dependent macroreentry. This algorithm correctly differentiated the focal from macroreentrant ATs with a sensitivity of 94%, specificity of 91%, and predictive accuracy of 92% in Group 2. Conclusion: Different electrophysiological properties may facilitate the differentiation between macroreentrant and focal ATs after CPVI.

AB - Macroreentrant and Focal Atrial Tachycardias. Background: Atrial tachycardias (ATs) are commonly observed following catheter ablation of atrial fibrillation (AF). The aim of this study was to identify ECG characteristics that differentiate focal from macroreentrant ATs after circumferential pulmonary vein isolation (CPVI). Methods and Results: One hundred and twenty ATs that occurred after CPVI were mapped using a 3-dimensional mapping system in 87 patients with AF. Further ablation was performed to eliminate the ATs. The surface ECGs of 68 ATs in 41 consecutive patients (Group 1) were analyzed retrospectively to create diagnostic algorithms. The algorithms were tested in the second 46 consecutive patients (Group 2). Patients with macroreentrant AT had lower left atrial (LA) voltage than those with focal AT (1.3 ± 0.3 vs 1.5 ± 0.2 mV, P = 0.01). Focal AT had a higher incidence of a positive polarity in V6 compared with macroreentrant AT (88% vs 55%, P = 0.03). The positive amplitude of the flutter/P waves in V6 was higher for focal AT than macroreentrant AT. The cycle lengths of the focal ATs were longer than those for macroreentrant AT (296 ± 107 vs 244 ± 25 ms, P < 0.001). Right atrial macroreentrant AT had a higher incidence of a negative polarity in at least 1 precordial lead compared with LA macroreentry. The positive flutter waves in V1 could differentiate roof/mitral isthmus dependent from non-roof/mitral isthmus dependent macroreentry. This algorithm correctly differentiated the focal from macroreentrant ATs with a sensitivity of 94%, specificity of 91%, and predictive accuracy of 92% in Group 2. Conclusion: Different electrophysiological properties may facilitate the differentiation between macroreentrant and focal ATs after CPVI.

KW - algorithm

KW - atrial fibrillation

KW - atrial tachycardia

KW - ECG

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DO - 10.1111/j.1540-8167.2010.02002.x

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AN - SCOPUS:79960709046

SN - 1045-3873

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EP - 755

JO - Journal of cardiovascular electrophysiology

JF - Journal of cardiovascular electrophysiology

IS - 7

ER -

Differentiating macroreentrant from focal atrial tachycardias occurred after circumferential pulmonary vein isolation

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